Mental Health Care Act, 2002 (Act No. 17 of 2002)RegulationsGeneral RegulationsAnnexuresForm MHCA 23 |
ANNEXURE
FORM MHCA 23
DEPARTMENT OF HEALTH
TRANSFER OF STATE PATIENTS FROM DETENTION CENTRE TO A DESIGNATED HEALTH ESTABLISHMENT
(Sections 42(3) of the Act)
OR
TRANSFER OF MENTALLY ILL PRISONERS FROM PRISON TO DESIGNATED HEALTH ESTABLISHMENT
(Section 53(2) of the Act)
Surname of state patient / mentally ill prisoner .....................................................
First name(s) of state patient / mentally ill prisoner ................................................
Date of birth ...............................or estimated age ....................
Gender:
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Male |
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Female |
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Occupation ..................................................................................................... |
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Marital status: |
S |
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M |
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D |
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W |
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Residential address:
..................................................................................................................
..................................................................................................................
The above state patient, currently held in detention at ...................................................(name of detention centre) must be transferred to
................................................(name of health establishment) for care, treatment and rehabilitation services.
Signature: ......................................................
(Head of national department)
Date: ......................
Place: .......................................
[Copy to be forwarded to head of detention centre and the official curator ad litem]
[On receipt of a court order in terms of section 42(1) of the Act, Form J105, the national department must complete MHCA 23 and forward a copy to the detention centre and head of health establishment concerned]